* Items marked with an asterisk are required.
* Email Address:
* First Name: 
Middle:
* Last Name: 
* Date of Birth: 
* Daytime Phone: 
 ( ) -  ext.
Evening Phone: 
 ( ) -  ext.
Cell or Other Number: 
 ( ) -  ext.
Name of Physician:
1st choice:  ----
2nd choice:  ----
3rd choice:  ----
or First Available:
*Do you have Insurance?
 Yes: No:
Insurance Company:
ID Number:
Insurance Co. Phone :
 ( ) -
Group Number:
Existing patient?
 Yes: No:
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A member of our staff will contact you to confirm your appointment.
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Are You A New Patient?
If you are a new patient making your first appointment with Access Medical Group, please come to the office a full 15 minutes before your appointment time to fill out the always popular new patient paperwork.
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If you have insurance please bring in your insurance card. You may also bring in any medical records, xrays or documents that you feel will be relevant.
Request For An Appointment
Marina del Rey's First Choice for
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Internal Medicine • Urgent Care • Family Medicine
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Official team Internists for the Los Angeles Clippers NBA basketball team
Accepted PPO Plans:
We accept most PPO Plans, including: Aetna PPO • Beech Street™ • Blue Cross PPO Prudent Buyer™• Blue Shield • CCN™ • Cigna • Medicare • Medi/Medi • United Healthcare™ • PHCS™ • Health Net PPO™ • Humana PPO™ • PacifiCare™
 
Accepted HMO Plans:
Blue Shield™ • Blue Shield 65+™ • Cigna™ • Aetna™ • One Health Plan™ • PacifiCare™ • Blue Cross™ • Secure Horizons™• Health Net™ Universal Care™
  
Service Area Includes: Marina del Rey • Venice • Culver City • Westchester • Redondo Beach • West Los Angeles • Santa Monica • El Segundo • Manhattan Beach
  
Hours of Operation:
Appointments
9 AM –5 PM Monday – Friday
Urgent Care and Walk-In Patients
9 AM –5 PM Monday – Friday
9 AM –12 Noon Saturday/Sunday
Red Cross   Urgent Care and Walk-In Patients Accepted 7 Days per Week
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On the campus of Marina del Rey Marina Hospital since 1984